Organization
ISSAIAH HOUSE INC
Active
Parent organization
ISSAIAH HOUSE INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ISSAIAH HOUSE INC
Authorized official
MR. DARRYL BRAXTON LCPC (OWNER)
(443) 882-1943
Entity
Organization
Contact information
Practice address
919 CALWELL RD, BALTIMORE, MD 21229-5006
(443) 882-1943
(410) 558-6222
Mailing address
919 CALWELL RD, BALTIMORE, MD 21229-5006
(443) 882-1943
(410) 558-6222
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160026500
—
MD
Enumeration date
12/09/2020
Last updated
01/07/2021
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